CARE HOMES FOR OLDER PEOPLE
Aveley Lodge Abberton Road Fingringhoe Colchester Essex CO5 7AF Lead Inspector
Neal Cranmer Key Unannounced Inspection 19th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Aveley Lodge Address Abberton Road Fingringhoe Colchester Essex CO5 7AF 01206 729304 01206 729304 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Robin Parmenter Dr Anthony Snell, Mrs Jenny Snell Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may accommodate 21 persons of either sex who only fall within the category of Old Age 13th January 2006 Date of last inspection Brief Description of the Service: The home is owned by Dr and Mrs Snell and Mr Parmenter. Mr Parmenter is currently acting as the manager of Aveley lodge. The home is situated in the village of Fingringhoe, Essex, and benefits from being within reasonable bus/car ride of a range of local amenities provided by the historical town of Colchester. Aveley Lodge offers a number of single rooms, some of which have en-suite facilities. The home has two lounges and a conservatory area. Extensive grounds can be found to the rear of the property. The range of monthly fees supplied to the Commission for Social Care Inspection (CSCI) on the 19th May 2006 is between £1,400 and £1,560 per month with an additional charge being made for hairdressing. This information was provided verbally to the inspector at the time of the inspection. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This report follows an unannounced inspection to Aveley Lodge, which took place on 19th May 2006, the first inspection at the home for the year 2006/2007 with the assistance of the acting manager and their assistant, service users and staff. The fieldwork visit was carried out between the hours of 09:15 and 16:00. Service users, staff and visitors were spoken with, and a range of records and files were sampled. A total of fourteen key standards were inspected, of which seven were met, five were minor shortfalls, and with the remainder being major shortfalls. Discussions with service users during the course of the inspection were generally positive. All were complimentary of the environment and cleanliness of the home, and were positive in relation to comments made about staff and the way that they were supported. In addition to discussion with service users on the day of the visit, four service users surveys were left to be completed at leisure by service users, all of which were returned between the date of the visit and the writing of this report; comments/responses from these have been incorporated into this report. A tour of the premises was undertaken, which were seen to be well decorated and maintained, and designed to meet the needs of the service users in residence. What the service does well: What has improved since the last inspection?
Many of the requirements from the previous two inspections remain outstanding, although it is recognised that some significant development has been made towards these being met. The home’s pre admission assessment has been further developed and now meets with requirements. Healthcare records are now more detailed and easier to trace within the care plan files.
Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 6 The home’s recruitment practices have been improved, although further work is required to ensure that they are complying with regulatory requirements. This is important in ensuring that risks to service users are minimised through the use of robust recruitment. There has been concern about the day-to-day operations of the home for a considerable time. This particularly relates to the fact that the home has been operating without a registered manager and continues to be the case. However, there does appear to be some light at the end of this tunnel as it is understood that this matter will now be addressed in the not too distant future. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. The home has an effective pre admission assessment for assessing the needs of service users prior to a service being offered. EVIDENCE: Discussion with the manager, and evidence provided, showed that the home now has in place a pre admission assessment that will be used for all new referrals made to the home, the home will use this to assess the home’s ability to meet the service user’s needs prior to a service being offered. The home continues to provide intermediate care. The admission process for the service user most recently admitted for intermediate care was sampled and found to be in order. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 8. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Care plans require some further development to ensure that identified objectives can be met. Service users’ healthcare needs are well met and records are well maintained. EVIDENCE: Care plans have been much improved since the last inspection. However, further development is required to ensure that the guidance provided to staff on how to support service users towards meeting their identified needs would benefit greatly by being written in a more concise manner. Currently they are not sufficiently specific enough to enable a new carer to pick them up and be able to have a good understanding of the service users’ needs. Records relating to service users’ healthcare needs were well maintained. All service users are registered with a general practitioner and evidence was seen of other healthcare professionals providing input into the home, for example, District Nurses.
Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 10 Two of the three service users’ surveys indicated that the home always provides service users with the medical support they require; one survey did not indicate any response and the fourth indicated that relevant medical support is usually provided. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: Key standards 12, 13, 14, and 15 were inspected and were fully met at the home’s last inspection. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The home’s Adult Protection Policy/Procedure continues to require some further development to ensure that service users are adequately protected. EVIDENCE: The home has in place an Adult Protection Policy/Procedure which provides basic information on adult protection. However, it was recommended that the policy/procedure be further developed in respect of guidance to staff on what course of action to be followed in the event of an allegation of abuse being brought to their attention. Evidence was provided that all staff have now received training in adult protection. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users live in an environment that is safe and maintained to a very good standard. The home always presents as being very clean and hygienic, and on the day of the inspection was free of any unpleasant odours. EVIDENCE: Tour of the premises evidenced that the home is very homely and maintained to a very high standard. The grounds of the premises were seen to be kept tidy and attractive, and the building was equipped with wheelchair ramps from all exits enabling service users access to the grounds. The whole of the outside was seen to be accessible whilst at the same time being safe. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 14 The laundry facility at the home is situated well away from areas where food preparation takes place and does not intrude upon service users. Hand washing facilities were available, and the laundry room was clean. On the day of the inspection the home was found to be very clean and was free from any unpleasant odours. All four service user surveys returned following the visit stated that the home is always fresh and clean. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The home is currently not meeting the need for its staff team to be qualified at N.V.Q level 2. The home’s recruitment practice does not adequately protect service users. The home needs to ensure that all new starters to the home receive appropriate induction. EVIDENCE: The home employs eighteen care staff, six of who have obtained a National Vocational Qualification level two in care, and one has obtained a level three. A further five have now commenced their level two award. The home does not employ any carers under the age of eighteen. Although the home’s recruitment practice has improved significantly since the last inspection, there remain a number of gaps, for example, there is no clear evidence that all staff have received any induction or that staff are being provided with any formal supervision. The home needs to ensure that all staff receive a structured induction within six weeks of the date of their appointment.
Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. The home does not have a registered manager in post with responsibility for the day-to-day running and management of the home. The home’s process for keeping the quality of its service provision under review continues to require further development. The home ensures that service users’ financial interests are protected. There is no formal process in place to ensure that staff are appropriately supervised. The home’s safe working practices are adequate to ensure that service users’ and staff health and welfare are promoted and protected. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 17 EVIDENCE: The home has not had a registered manager in post for a considerable period of time. Discussion with the acting manager indicated that this matter should be resolved in the not too distant future. The home has a process for reviewing and keeping under review the quality of its service provision. This includes seeking the views of service users and their relatives through the use of questionnaires. Discussion took place around the need to develop this further by expanding the questionnaires to include a range of other interested stakeholders, e.g. • • • • District Nurse Chiropodists General practitioners Social Workers The home will then need to give consideration as to how to use this information to drive the service forward. The only monies held by the home on behalf of service users was pocket money. Records relating to this were sampled and found to be in order. There was a clear audit of money coming in, expenditure made and the current balance held by the home. Discussions with the acting manager and staff evidenced that there is currently no process in place for formal supervision, although the acting manager presented evidence of plans for this to be implemented. The home’s safe working practices were sampled through the viewing of the following certificates: • • • • • • Environmental Health Officer’s report Electrical Installation Certificate Gas Installation Certificate Fire Alarms Emergency Lighting Hot Water Temperature Checks (checked weekly) There was no evidence to indicate that staff had received foundation training in safe working practices. Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X X STAFFING Standard No Score 27 X 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 1 X 2 Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 19 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP30 Regulation 18 (i) Requirement The responsible person must ensure that all staff receive necessary training in safe working practices to ensure that service users and their health and safety are protected and promoted. The responsible person must ensure that all the documentary evidence pertaining to staff recruitment is held on file as per the requirements of Schedule 2 of the Care Homes Regulations. The previous timescales of June 2005, 31st October 2005 and 28th February 2006 were not met. The responsible person must make provision for the appointment of an individual to manage the care home. The previous timescale of 31st March 2006 was not met. Timescale for action 30/08/06 2. OP29 18 28/08/06 3. OP31 8 31/08/06 Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 20 4. OP33 24 5. OP36 18 (2) The responsible person must develop a process for reviewing and keeping under review the quality of the home’s service provision. The responsible person must ensure that all staff working at the home receive appropriate supervision. The previous timescales of June 2005, 31st October 2005 and 31st March 2006 were not met. 31/08/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that the service users’ care plans be further developed by expanding on the level of guidance provided to staff on how the identified need objective should be met. It is recommended that the home’s Adult Protection Policy/Procedure be further developed to ensure it provides staff with clear guidance. 2. OP18 Aveley Lodge DS0000017757.V290119.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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